Republicans’ sweeping and cruel last-ditch effort to repeal Obamacare

Republican Senators Bill Cassidy (Louisiana) and Lindsey Graham (South Carolina) have come up with yet another effort to dismantle the Affordable Care Act—and this the most harmful repeal bill yet. They are trying to rush it through by September 30 while only a simple majority is needed to pass it and before the Congressional Budget Office has time to release its scoring. Among the provisions in this latest repeal bill are preventing people with Medicaid coverage (who are more than half of all Planned Parenthood patients) from getting care at Planned Parenthood health centers.

This “last-ditch attempt to repeal...the Affordable Care Act would leave millions of women without coverage for birth control, maternity care, abortion care, or essential preventative care like cancer screenings and STD testing and treatment,” said Andrea Miller, president of the National Institute for Reproductive Health. “Like its predecessors, the Graham-Cassidy bill preys on underserved communities. The bill would leave the decision of whether to cover essential health benefits to the states and limit access on the individual market to insurance that covers abortion care.” Close to 13 million women could lose coverage for maternity care.

One of the cruelest aspects of the bill is a complex block grant scheme that punishes states that have expanded Medicaid or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA, according to the Center for Budget and Policy Priorities. And it would increase funding, at least initially, in states that have either rejected Medicaid expansion or enrolled few low-income residents in marketplace coverage.

“This latest version of Trumpcare is a terrible bill for women, especially low-income women and women of color,” said Joanna Saul, vice president of government affairs and public advocacy at Planned Parenthood Advocates of Ohio. “It slashes Medicaid, which one in five women of reproductive age rely on for care, including birth control and cancer screenings. And it guts maternity coverage.” Before the ACA, 75 percent of individual market plans excluded maternity coverage.

The bill places per capita spending caps on Medicaid, and funding losses to states could exceed $215 billion from 2020 to 2026 and more than $4 trillion over the next 20 years; Ohio alone stands to lose $9 billion. "Ohio is at the epicenter of an opioid epidemic, and we have a huge population in need of additional services, not less services,” said Saul.

Under this bill, 32 million people are projected to lose coverage after 2026 because ACA marketplace subsidies and Medicaid expansion would be repealed in 2020, according to the Commonwealth Fund. An estimated 15-18 million people could become uninsured in the first full plan year after the enactment because the bill repeals the individual and employer mandates requiring coverage or the offer of coverage.

“Prior to implementation of the ACA, LGBTQ people had some of the lowest insured rates of any population in the country,” said Julianna Gonen, policy director at the National Center for Lesbian Rights. “The individual market reforms, including the ban on pre-existing condition exclusions, have made it possible for many in our community to obtain health insurance for the first time in their lives. For many people living with HIV, as one example, this particular reform has made insurance affordable and treatment accessible. The one-two punch of gutting Medicaid and eliminating the ACA’s marketplace subsidies would strip coverage away from millions.”

Half the U.S. population lives in states that are likely to enact waivers eliminating consumer protection or reducing required benefits, including maternity care and mental health care. States would be allowed to end pre-existing condition protections; the Center for American Progress estimates that premium surcharges for certain health conditions such as pregnancy would be tens of thousands of dollars.

“There is no way around it: the most recent efforts to repeal the ACA are a blatant and systematic attack against historically underserved communities,” said Jessica González-Rojas, executive director at the National Latina Institute for Reproductive Health. “Knowing that our lives lie in the hands of politicians that do not care whether we live or die is terrifying. But with every attack against us, our community grows stronger and more powerful. Yes, there is fear and panic, but there is also resiliency. We are fighting back with all that we’ve got, and we will not rest until conservative lawmakers stop interfering with our access to quality, affordable health care. This fight is far from over.”

As of Thursday morning, there was one scheduled hearing on the repeal: Monday, September 25 at 2 p.m. in the Dirksen Senate Office Building.